Better, A Surgeon's Notes on Performance, by Atul Gawande is a deft look at many of the obstacles and dilemmas facing doctors today. I should offer a disclaimer: I love books written from a medical perspective and have been poking my nose in these sorts of books since I was a child.

This is no ordinary book of medical procedures and a doctor's history with patients. Gawande takes us inside many of the issues he faces as an M.D. each day and some of the larger ethical dilemmas facing medicine. Gawande is a surgeon himself and as such, presents a clear perspective on each issue he raises.

One of the most fascinating discussions he raises is that of doctors participating in prisoner executions. He uses the cases of three doctors and one nurse who have all participated in executions, some of who are personally opposed to the death penalty, but still participate. The AMA bans physicians from participating in executions, except for administering a sedative if requested by the inmate and signing a death certificate after another has pronounced the death of the prisoner. Despite the AMA ban, the physicians participate for varying reasons, ranging from seeing the execution as no different from deadly cancer to wanting to be a calming force for the condemned.

Gawande also takes on issues of medical insurance in some depth, coming to no conclusion except that the issue is extraordinarily complex and needs to be tackled in a real way. His descriptions of the insurance paperwork and headaches from the insurance companies are frustrating to read--as he comments, a doctor truly needs to be a businessman first and foremost, and the first person he should hire is an insurance administrator, to make sure every penny is received for the services rendered.

He talks about issues of end of life care and when a doctor should say "when" and when he should keep on with a patient with a not-so-good prognosis. One of the examples he gives regards a young relative of his who is stricken with lymphoma and her parents' agonizing decisions as to when to go for yet another round of radiation that isn't working and when to let go. On the other hand, he mentions the case of an elderly woman who looked for all the world like she was about to die who recovered and had a productive, happy several years with her family. Again, his point is how many shades of gray there are in a doctor's daily decision-making.

My enjoyment of medical reading aside, I would recommend this book to anyone with an interest in current medical ethics and debates. Gawande is gifted not only with surgical abilities, but with a clear, open writing style that draws his readers into the book--had I not needed to earn a living and sleep, I would have read this book cover to cover.